Poor Air Quality and Asthma

Recent fires in California are contributing to poor air quality, and recently we have seen an increase in asthma exacerbations. While allergies are a major trigger for asthma symptoms, poor air quality, as well as respiratory tract infections certainly can exacerbate symptoms as well. Let’s take a moment to review what asthma is, and how it affects children and adults.

Asthma is a common disease that affects the lungs. About 15 million Americans have asthma. People who have asthma often experience wheezing, coughing, increased mucous production and difficulty breathing. These symptoms are caused by inflammation and/or obstruction of the bronchial airways, which transport air from the nose and mouth to the lungs. Many people with asthma have allergies “triggered” by various allergens, such as dust, pollen and mold. These allergens can cause the tissue that lines the bronchial airways to become inflamed.

Although asthma is more common in children, adults and older people also frequently develop asthma. Asthma in adults can be a recurrence of childhood asthma. But adult onset asthma generally refers to the onset of asthma for the first time in someone of middle age or older.

There is evidence that asthma and allergy have a strong genetic factor. It is also increasingly recognized that asthma is not one single disease, but has several subtypes. The most common type of asthma occurs in children and is associated with allergies, whereas asthma that starts in adulthood is less common, but may show a severe progressive course in some patients. To identify these patients with severe, adult-onset asthma at an early stage, and to better understand the underlying mechanisms, it is important to determine whether an underlying allergy is contributing to the problem and take appropriate steps to deal with this condition.

In a research study published in The Journal of Allergy & Clinical Immunology examining patients with adult-onset asthma with respect to clinical, functional and inflammatory markers, the researchers found that patients with severe adult-onset asthma had more nasal symptoms and higher incidence of sinus disease including nasal polyps. Most had increased exhaled nitric oxide levels (FeNO) and these findings persisted despite treatment and were not correlated with age, sex, or how long they have had asthma. Further analyses showed that some other markers of allergic inflammation were independently associated with having severe disease. The authors’ findings suggest that severe adult-onset asthma is a distinct asthma subtype that has different underlying mechanisms as compared to milder forms of adult-onset asthma but also as compared to severe asthma in general.

In some cases, asthma simply persists into adulthood and in others, childhood asthma clears up for a number of years only to reappear later in life. The way that adult onset asthma compares to childhood asthma is that unlike children who often experience intermittent asthma symptoms in response to allergy triggers or respiratory infections, adults with newly diagnosed asthma generally have persistent symptoms.

After middle age, most adults experience a decrease in their lung capacity. These changes in lung function may lead some physicians to overlook asthma as a possible diagnosis. Asthma can mimic other illnesses or diseases, especially in older adults, and untreated asthma can contribute to even greater loss of lung function. Diseases that have similar asthma-like symptoms can include: hiatal hernia, reflux or other stomach problems; rheumatoid arthritis; chronic obstructive pulmonary disease (COPD); emphysema or chronic bronchitis.

If you or a loved one are experiencing symptoms that haven’t been experienced before or at least not for a long while-- symptoms such as a dry cough (especially at night or in response to specific “triggers”); tightness or pressure in the chest; difficulty breathing; wheezing or a whistling sound when exhaling; shortness of breath after exercise; or colds that go to the chest and “hang on” for 10 days or more, you could be experiencing adult onset asthma. If you have any of these symptoms, don’t ignore them or try to treat them yourself. Get a definitive diagnosis from an allergy & asthma specialist who can understand your symptoms, conduct appropriate lung function testing and test for allergies. This will provide the necessary clinical information to make a correct diagnosis and come up with appropriate treatment options to control and reduce your symptoms and help you feel better. If your child has just started back to school, be sure they have current medications and school forms in place to ensure their medications are correctly administered.